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Outcomes of isolated CABG from "OPCAB favor institution" for patients with left ventricular dysfunction

Yoshifumi Itoda1, Kazuki Morooka2, Retsu Tateishi2

  • 1Department of Cardiovascular Surgery, IMS Katsushika Heart Center, 3-30-1, Katsushika, Tokyo, 124-0006, Japan. yitoda30@gmail.com.

General Thoracic and Cardiovascular Surgery
|December 3, 2022
PubMed

Insights

Off-pump coronary artery bypass (OPCAB) and on-pump coronary artery bypass (ONCAB) outcomes were compared in patients with low ejection fraction. OPCAB demonstrated better results, supporting its use in carefully selected patients with impaired cardiac function.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Function Assessment
  • Surgical Outcomes Research

Background:

  • Coronary Artery Bypass Grafting (CABG) is a standard treatment for coronary artery disease.
  • Patients with low ejection fraction (<35%) present unique challenges for CABG.
  • Off-pump CABG (OPCAB) may offer advantages over on-pump CABG (ONCAB) in this population, but evidence is limited.

Approach:

  • Retrospective review of 67 patients with low ejection fraction undergoing isolated CABG (2013-2020).
  • Comparison of outcomes between OPCAB (n=54) and ONCAB (n=13) groups.
  • Analysis included preoperative comorbidities, intra-operative events, postoperative support, and survival rates.

Key Points:

  • ONCAB patients had more comorbidities like AMI, heart failure, and cardiogenic shock.
  • ONCAB group required more mechanical circulatory support and had worse outcomes regarding blood transfusion, ICU stay, intubation, and hospital stay.
  • Postoperative graft patency was 91.5%, with 7.5% hospital mortality and favorable mid-term survival rates (98.5% at 30-day, 84.6% at 1-year, 75.8% at 5-year).

Conclusions:

  • The study suggests ONCAB was reserved for patients unable to complete OPCAB due to severe preoperative circulatory compromise.
  • The treatment policy of utilizing OPCAB and carefully selecting ONCAB for high-risk patients with impaired cardiac function was deemed acceptable.
  • OPCAB appears to be a safe and effective strategy for selected patients with severely reduced ejection fraction.
Abstract

Keywords:
Left ventricular dysfunctionOff-pump coronary artery bypassOn-pump coronary artery bypass

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